© cengage learning 2016 suicide 9. © cengage learning 2016 the intentional, direct, and conscious...

© Cengage Learning 2016 © Cengage Learning 2016

Suicide

9

© Cengage Learning 2016

• The intentional, direct, and conscious taking of one’s own life

• Has been extensively researched– Risk factors and protective factors identified

– Strategies to successfully intervene identified

• Of people who contemplate suicide, up to 90 percent have a mental illness– Often undiagnosed

Suicide


• 10th leading cause of death in the U.S.

• Throughout history, people have avoided discussing suicide

• Psychological autopsy– Systematically examining information after a

person’s death in effort to understand and explain behavior

Facts About Suicide


Common Characteristics of Suicide


• About one million adults attempt suicide each year– One completed suicide for every 25 attempts

– Ratio of attempts to suicides much greater for the young

• Suicidal behavior and ideation begin with individual’s initial suicide thoughts– Some people develop a plan

• Smaller number attempt suicide

Prevalence of Suicidal Behavior


Pictorial Representation of Suicide Prevalence


• Suicide is third leading cause of death among college students

• Actual suicide rate may be 25-30 percent higher than recorded– Some deaths deemed accidental may have

actually been suicides

Prevalence of Suicide (cont’d.)


• Firearms– More than 50 percent of completed suicides

• Drug overdose– 70 percent of suicide attempts

• Hanging/suffocation– Increased in recent years for all age groups

• Especially among ages 45-59

• Older adolescents most frequently try hanging, jumping, and using firearms

Choice of Method


• Higher than average suicide rates– Physicians

• Highest among psychiatrists; lowest among pediatricians

• Researchers speculate risk factors include burnout, stress, drug availability, and guilt over medical errors

– Lawyers

– Law enforcement personnel

– Dentists

Occupational Prevalence


• Consistent themes among surviving friends– Guilt, and an attempt to understand the

tragedy

– Development of risky behaviors

– Altered relationships with friends

• Surviving family members, especially parents, often feel guilt and responsibility– Increased rates of depression, anxiety,

alcohol abuse, and marital difficulty

Effects of Suicide on Friends and Family


• Suicide of a parent can have lifelong effects– Child has increased risk of developing mental

health problems

– Increased risk of suicide, especially if deceased parent was the mother

Suicide Effects on Children


• Suicide among children and adolescents– 15.8 percent of high school students seriously

consider attempting suicide

– 7.8 percent had made an attempt in previous 12 months

– Higher rates for female students than male

– Hispanic/Latino and American Indian/Alaska Native females have highest rate of attempted suicides

Suicide and Specific Populations


• Bullying– Victims of bullying are two to nine times more

likely to consider suicide than those not subject to bullying

– Promising sign that people are willing to intervene when they observe bullying

• Copycat suicides– Media reports

• Decreased use of antidepressants within this age group

Possible Reasons for Increase of Suicide in Children and Adolescents


• 2004 U.S. Food and Drug Administration warning of increased suicide risk for children taking SSRIs– Warning is required to be distributed with all

such medication

– Controversy over these actions

– Effect of SSRIs on suicide rates is still unresolved

• Medical professionals should monitor suicidal ideation

Trends in Antidepressant Use in Children


• Increasing rate of suicides in the military– 349 deaths in 2012, more than the 295

combat-related deaths in Afghanistan during same period

• Factors contributing to increased risk– Barriers to mental health care in the military

– PTSD

– Frequent separation from family

– Loss of comrades

Suicide Among Military Veterans


• Comprehensive study of suicidal ideation in students at over 70 colleges– More than 50 percent reported suicidal

thoughts

– 18 percent seriously considered attempting suicide

• Among these, 90-92 percent had a specific plan

– Between eight and 14 percent had made an attempt

Suicide Among College Students


• Approximately 80 percent of students who die by suicide did not seek professional help– 45 percent never tell anyone about their

intentions

• Some signs of suicidal risk– Verbalizing intentions

– Withdrawal and depression

– Giving away prized possessions

Suicide Among College Students (cont’d.)


• Baby boom generation– Born between 1946 and 1964

– Consistently higher suicide rates than previous or subsequent generations

• 50 percent rate increase between 1999 and 2010 for people in their 50s

• Suicide prevention programs typically focus on youths and older adults

Suicide Among Baby Boomers


• Suicide rates for elderly men are the highest of any age group

• Suicide likely to accompany depression

• Factors for increased risk– Significant health issues

– Loss of independence

– Bereavement

– Serious financial and relationship problems

Suicide Among the Elderly


• Suicide influenced by low serotonin levels in the brain– 5-hydroxyindoleacetic acid (5HIAA)

• Produced when body metabolizes serotonin

• Low levels of 5HIAA in those who died from suicide

• Genetics – Relationship is unclear

– Certain endophenotypes associated with suicide

Multipath Perspective of Suicide: Biological


Multipath Model of Suicide


• Many have history of mental illness

• Factors of particularly high risk– Depression

– Bipolar disorder

– Schizophrenia

– Eating disorders

– Some anxiety and personality disorders

– Substance abuse

Multipath Perspective of Suicide: Psychological


• Psychological states most strongly associated with suicide– Even mild depression increases risk

– Limited energy associated with severe depression makes suicide less likely

• Psychache– Intolerable pain created from an absence of

joy

– Strongly associated with suicidal ideation

Depression and Hopelessness


• One of most consistent correlates– As many as 70% of suicide attempts involve

alcohol

– Strong correlation to successful attempt

• May lower inhibitions related to fear of death

• Alcohol-induced myopia– Focusing thoughts on the negative aspects of

personal situations

Alcohol Consumption


• Many suicides are interpersonal in nature– Occur following relationship conflicts

• Disconnection from friends, family, religious institution, or community– Increases susceptibility to suicide

• Factors in children who consider suicide– Loss of significant parenting figure before age

12

– Abuse, and unpredictable traumatic events

Multipath Perspective of Suicide: Social


• Two social factors strongly associated with suicide attempts (Joiner)– Perceived burdensomeness

– Thwarted belongingness

• Third factor: acquired capacity for suicide– Reduction in fear of taking one’s own life

– Repeated exposure to traumatic life events may lower this fear

Multipath Perspective of Suicide: Social (cont’d.)


• Stable marriage or relationship makes suicide less likely

• For women, having children decreases suicide risk

• People who are divorced, separated, or widowed have higher suicide rates than the married

• Death of a spouse associated with 50 percent higher suicide rate for men

Marital Status


• Emile Durkheim’s sociocultural theory– Inability to integrate oneself into society

– Lack of close ties deprives one of support systems necessary for adaptive functioning

• Other sociocultural factors– Modern technological society

– Alienation of lesbian, gay, bisexual and transgender youth

Multipath Perspective of Suicide: Sociocultural


• Highest rate of completed suicides– American Indian/Alaska Native

– European American males

• Lower rates– African American

– Hispanic/Latino

– Asian American/Pacific Islander

• Social change and disorganization may be a contributing factor

Ethnic and Cultural Variables


• Females have higher rates of suicidal thoughts and attempts

• Death from suicide occurs much more frequently among males– 79 percent of all U.S. suicides

• Males tend to choose most lethal methods

• Drug overdose/poisoning most common means for women

Gender


• During recession that began in 2008– U.S. suicides increased by 1,580 from 2008-

2010

• During Greece’s economic challenges– Suicide rate increased by more than 60

percent

• Risk factors– Unemployment

– Bankruptcy

Socioeconomic Stressors


• Suicide rate is lower in countries where the Catholic Church has a strong influence

• Islam also condemns suicide– Medical students in the United Arab Emirates

reported low lifetime prevalence of suicidal thoughts and attempts

• Where religious sanctions against suicide are weak or absent, higher suicide rates are observed

Religious Affiliation


• Early detection and successful intervention– Understanding risk and protective factors

• Paths to intervention– Self-referrals or referrals from concerned

family or friends

– Gatekeeper training• Designated people within a system learn about risk

factors and screening methods

Preventing Suicide


Risk and Protective Factors in Suicide Assessment and Intervention


• Three-step process– Know which factors increase likelihood of

suicide

– Determine probability that person will act on suicide wish (high, moderate, or low)

– Implement appropriate actions

Working with a Potentially Suicidal Individual


• Clues may be demographic or specific

• Specific clues– Previous suicide attempts

– Having suicidal ideation or a suicide plan

– Verbal communications of intent

– Withdrawal, restlessness, changes in sleep patterns

– Saying goodbye and putting affairs in order

Clues to Suicidal Intent


• Crisis requiring immediate preventive assistance can occur any time, day or night– Hotlines typically operate 24/7

– Numbers publicized throughout the community

• Staffers are trained in crisis intervention techniques

Suicide Hotlines and Telephone Crisis Intervention


• Can be highly successful for those who independently seek professional help– Or are encouraged to seek help

• “No-harm” agreement– Written agreement between a suicidal person

and therapist or person involved in crisis intervention

– Lack of research supporting effectiveness

• Temporary hospitalization

Suicide Crisis Intervention


• Treatment often involves both medication and psychotherapy

• CBT and DBT proven to reduce suicide risk by 50 percent compared to other forms of therapy– CBT focuses on vulnerabilities

– DBT focuses on helping clients accept current lives and emotional anguish

Psychotherapy for Suicidal Individuals


• Treatment program involves:– Chain analysis

– Safety planning

– Psychoeducation

– Building hope and addressing reasons for living

– Learning and using adaptive strategies from CBT and DBT to deal with specific problems

CBT for Suicide Prevention


• Considering suicide as a psychiatric disorder in its own right– “Suicide behavior disorder” being studied

• DSM-5 encourages therapists to ask about suicidal thoughts

• Durkheim Project– Linguistic-based prediction models to

analyzing postings on social media to estimate individual’s suicide risk

Contemporary Trends and Future Directions


• What do we know about suicide?

• How is suicide unique in different age groups?

• How does suicide affect friends and family?

• What might cause someone to commit suicide?

• How can we prevent suicide?

• What are future directions in the field of suicidology?

Review

© cengage learning 2016 suicide 9. © cengage learning 2016 the intentional, direct, and conscious...

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